REGISTRATION

NEW STUDENT REGISTRATION

We are currently accepting application forms for the 2022-2023 school year. Please fill out ALL fields of this form. If you have any questions or concerns you would like to discuss with us, please feel free to contact us.

Are you an existing student, returning for the new year? Register here.

We look forward to providing your children with an outstanding Hebrew and Jewish education!

For tuition rates, please click here.

REGISTRATION FORM

How many children are you registering today?
- 1
- 2
- 3
Child 1 Name*
First Last
Hebrew Name
DOB*
MM slash DD slash YYYY
Age*
Gender*
- Boy
- Girl
School*
Grade Entering*
Second Child
Child 2 Name*
First Last
Hebrew Name
DOB*
MM slash DD slash YYYY
Age*
Gender*
- Boy
- Girl
School*
Grade Entering*
Third Child
Child 3 Name*
First Last
Hebrew Name
DOB*
MM slash DD slash YYYY
Age*
Gender*
- Boy
- Girl
School*
Grade Entering*
Previous Jewish Education?
- Yes
- No
Where?
Please describe your family's Jewish background/education (if applicable).
Is the natural mother of the Child(ren) Jewish?*
- Yes
- No
Did the child, their biological mother, or biological grandmother undergo any conversion process or adoption?*
- Yes
- No
Please provide details:
Parent Information
Father's Name*
First Last
Hebrew Name
Home Phone
Father's Cell*
Father's Email*
Occupation*
Mother's Name*
First Last
Hebrew Name
Home Phone
Mother's Cell*
Mother's Email*
Occupation*
Address*
Street Address Address Line 2 City State ZIP Code
Synagogue affiliated with (if any):
Persons to be contacted in case of an emergency when parents cannot be reached. Please provide two contacts.
Name 1*
First Last
Phone*
Relationship to child*
Name 2
First Last
Phone
Relationship to child
Does your child have any allergies or other medical condition we should be aware of?*
- Yes
- No
Please describe them and indicate special precautions or care needed.
Does your child have an IEP or receive any behavioral or educational support in school? (Sharing this information with us enables us to create a Hebrew School environment in which your child can thrive)*
- Yes
- No
Please explain
If referred, by whom: (maximum 2)
Payment Options
(Annual tuition: Kindergarten: Free of charge. 1st Grade: Members $500, non-members $750. Grades 2-7: Members $750, non-members $1,250.)*
- Yes, we are members of Chabad of Port Washington
- No, we are not members of Chabad of Port Washington - $100 security fee per family
- Kindergarten Program, Free of Charge
Early Bird Special!
- Yes, I'm registering before July 15, 2022 and would like to receive the 10% discount.
Please choose one of the following payment options:*
- 1. One Full Tuition Payment
- 2. 10 Equal payments charged on the first of each month August - May
- 3. No Charge
Payment Method*
- Please Charge My Card Below
- I Will Send In A Check
- No Charge
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Billing Address*
Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Amount To Charge Today*
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad of PW Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Chabad of PW Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad of PW Hebrew School activities and that these pictures may be used for marketing purposes.*
- I Accept
Name*
Initials*

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Contact Us

516-767-8672
youth@chabadpw.org

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REGISTRATION

NEW STUDENT REGISTRATION

REGISTRATION FORM

Second Child

Third Child

Parent Information

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